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Death Without Warning?: A Clinical Postmortem Study of Suicide in 43 Israeli Adolescent Males

Death Without Warning?: A Clinical Postmortem Study of Suicide in 43 Israeli Adolescent Males Abstract • Forty-three consecutive Israeli male suicides, 18 to 21 years of age, that occurred during compulsory military service were studied using preinduction assessment data, service records, and extensive postmortem interviews with family and peers. At preinduction, subjects, as a group, appeared above average in intelligence, physical fitness, and measures predictive of successful adaptation to military service. Active duty performance was generally satisfactory. Ascertained post mortem, 53.5% met formal criteria for major depressive disorder; most cases, however, appeared recent and reactive. Narcissistic and/or schizoid traits were common. Substance abuse was absent and antisocial personality disorder was rare (4.7%). Furthermore, in eight patients (18.6%) no Axis I diagnosis could be made; half of these also lacked any significant Axis II pathology. These findings, at partial variance with US studies, suggest a complex relationship between suicide and mental disorder. The striking failure of intensive screening and preventive measures to prevent these suicides highlights unresolved questions of etiology and intervention. References 1. World Health Organization. World Health Statistics Annual . Geneva, Switzerland: World Health Organization; 1988. 2. Kovacs M, Puig-Antich J. Major psychiatric disorders and risk factors in youth suicide. In: Alcohol, Drug Abuse, and Mental Health Administration Report of the Secretary's Task Force for Youth Suicide: Risk Factors for Youth Suicide . US Dept of Health and Human Services publication (ADM) 89-1622 . 1989;2:143-159. 3. Shaffer D, Garland A, Gould M, Fisher P, Trautman P. Preventing teenage suicide: a critical review . J Am Acad Child Adolesc Psychiatry . 1988;27:675-687.Crossref 4. Clark DC, Horton SL. Assessment in absentia: the value of the psychological autopsy method for studying antecedents of suicide and predicting future suicides . In: Maris RW, Berman AL, Maltsberger JT, Yufit RI, eds. Assessment and Prediction of Suicide . New York, NY: Guilford Press; 1992: 144-182. 5. Rich CL, Sherman M, Fowler RC. San Diego suicide study: the adolescents . Adolescence . 1988;25:855-865. 6. Hoberman HM, Garfinkel BD. Completed suicide in children and adolescents . J Am Acad Child Adolesc Psychiatry . 1988;27:689-695.Crossref 7. Shafii M, Carrigan S, Whittinghill JR, Derrick A. Psychological autopsy of completed suicide in children and adolescents . Am J Psychiatry . 1985;142:1061-1064. 8. Brent DA, Perper JA, Goldstein CE, Kolko DJ, Allan MJ, Allman CJ, Zelenak JP. Risk factors for adolescent suicide . Arch Gen Psychiatry . 1988;45:581-588.Crossref 9. Runeson B. Mental disorder in youth suicide: DSM-III-R Axes I and II . Acta Psychiatr Scand . 1989;79:490-497.Crossref 10. Marttunen MJ, Aro HM, Henriksson MM, Lonnqvist JK. Mental disorders in adolescent suicide . Arch Gen Psychiatry . 1991;48:834-839.Crossref 11. Arato M, Demeter E, Rihmer Z, Somogyi E. Retrospective psychiatric assessment of 200 suicides in Budapest . Acta Psychiatr Scand . 1988;77:454-456.Crossref 12. King RA, Pfeffer C, Gammon DG, Cohen DJ. Suicidality of childhood and adolescence: review of the literature and proposal for establishment of a DSM-IV category . In: Lahey BB, Kazdin AE, eds. Advances in Clinical Child Psychology . New York, NY: Plenum Press; 1992:297-325. 13. Van Praag HM, Kahn R, Asnis GM, Wetzler S, Brown SL, Bleich A, Korn ML. Denosologization of biological psychiatry, or the specificity of 5-HT disturbances in psychiatric disorders . J Affect Disord . 1987;13:1-8.Crossref 14. Levav I, Aisenberg E. Suicide in Israel: cross national comparisons . Acta Psychiatr Scand . 1989;79:468-473.Crossref 15. Levav I, Aisenberg E. The epidemiology of suicide in Israel: international and intranational comparisons . Suicide Life Threat Behav . 1989;19:184-200. 16. Reiger DA, Myers JK, Kramer M, Robins LN, Blazer DG, Hough RL, Eaton WW, Locke BZ. The epidemiologic catchment area program . Arch Gen Psychiatry . 1984;48:934-941.Crossref 17. Dohrenwend PB, Levav I, Shrout PE, Link BG, Skodol A, Martin J. Life stress and psychopathology . Am J Community Psychol . 1987;15:677-715.Crossref 18. Gal R. A Portrait of the Israeli Soldier . New York, NY: Greenwood Press; 1986. 19. Fishman G, Morris-Dycian A, Kotler M. Suicide in the Israeli army . Suicide Life Threat Behav . 1990;20:225-239. 20. Allebeck P, Allgulander C, Fisher LD. Predictors of completed suicide in a cohort of 50 465 young men: role of personality and deviant behavior . BMJ . 1988;297;176-178.Crossref 21. Angst J, Clayton P. Premorbid personality of depressive, bipolar, and schizophrenic patients with special reference to suicidal issues . Compr Psychiatry . 1986;27:511-532.Crossref 22. Brent DA, Perper JA, Allman CJ. Alcohol, firearms, and suicide among youth: temporal trends in Allegheny County, Pennsylvania, 1960-1983 . JAMA . 1987;257:3369-3372.Crossref 23. Schuckit MA, Schuckit JJ. Substance use and abuse: a risk factor in youth suicide . In: Alcohol, Drug Abuse, and Mental Health Administration Report of the Secretary's Task Force for Youth Suicide: Risk Factors for Youth Suicide . US Dept of Health and Human Services publication (ADM) 89-1622. 1989;2:172-183. 24. Van Vranken EW, McCraig CM, Golembe EH. US Army, Europe (USAREUR) Active Duty Suicides: US Army Medical Research Unit-Europe, Seventh Medical Command . Washington, DC: Walter Reed Institute of Research; June 20, 1986. 25. Rothberg JM, Fagan J, Shaw J. Suicide in United States Army personnel, 1985-1986 . Mil Med . 1991;155:452-456. 26. McDowell CP. Suicide Among Active Duty US Air Force Members, 1980-1989 . Washington, DC: USAF Office of Special Investigations, Bolling Air Force Base; April 1990. 27. Rothberg JM, Bartone PT, Holloway HC, Marlowe DH. Life and death in the US Army: in corpore sano . JAMA . 1990;264:2241-2244.Crossref 28. Redlich FC, Freedman DX. The Theory and Practice of Psychiatry . New York, NY: Basic Books; 1966. 29. Frances A, Blumenthal SJ. Personality as a predictor of youthful suicide. In: Alcohol, Drug Abuse, and Mental Health Admistration Report of the Secretary's Task Force for Youth Suicide: Risk Factors for Youth Suicide. Washington, DC: US Dept of Health and Human Services . US Dept of Health and Human Services publication (ADM) 89-1622 . 1989;2:160-171. 30. Shaffer D. Suicide in childhood and early adolescence . J Child Psychol Psychiatry . 1974;15:275-291.Crossref 31. Zetzel ER. The Capacity for Emotional Growth . London, England: Hogarth Press; 1970. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Death Without Warning?: A Clinical Postmortem Study of Suicide in 43 Israeli Adolescent Males

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Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1993.01820140064007
Publisher site
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Abstract

Abstract • Forty-three consecutive Israeli male suicides, 18 to 21 years of age, that occurred during compulsory military service were studied using preinduction assessment data, service records, and extensive postmortem interviews with family and peers. At preinduction, subjects, as a group, appeared above average in intelligence, physical fitness, and measures predictive of successful adaptation to military service. Active duty performance was generally satisfactory. Ascertained post mortem, 53.5% met formal criteria for major depressive disorder; most cases, however, appeared recent and reactive. Narcissistic and/or schizoid traits were common. Substance abuse was absent and antisocial personality disorder was rare (4.7%). Furthermore, in eight patients (18.6%) no Axis I diagnosis could be made; half of these also lacked any significant Axis II pathology. These findings, at partial variance with US studies, suggest a complex relationship between suicide and mental disorder. The striking failure of intensive screening and preventive measures to prevent these suicides highlights unresolved questions of etiology and intervention. References 1. World Health Organization. World Health Statistics Annual . Geneva, Switzerland: World Health Organization; 1988. 2. Kovacs M, Puig-Antich J. Major psychiatric disorders and risk factors in youth suicide. In: Alcohol, Drug Abuse, and Mental Health Administration Report of the Secretary's Task Force for Youth Suicide: Risk Factors for Youth Suicide . US Dept of Health and Human Services publication (ADM) 89-1622 . 1989;2:143-159. 3. Shaffer D, Garland A, Gould M, Fisher P, Trautman P. Preventing teenage suicide: a critical review . J Am Acad Child Adolesc Psychiatry . 1988;27:675-687.Crossref 4. Clark DC, Horton SL. Assessment in absentia: the value of the psychological autopsy method for studying antecedents of suicide and predicting future suicides . In: Maris RW, Berman AL, Maltsberger JT, Yufit RI, eds. Assessment and Prediction of Suicide . New York, NY: Guilford Press; 1992: 144-182. 5. Rich CL, Sherman M, Fowler RC. San Diego suicide study: the adolescents . Adolescence . 1988;25:855-865. 6. Hoberman HM, Garfinkel BD. Completed suicide in children and adolescents . J Am Acad Child Adolesc Psychiatry . 1988;27:689-695.Crossref 7. Shafii M, Carrigan S, Whittinghill JR, Derrick A. Psychological autopsy of completed suicide in children and adolescents . Am J Psychiatry . 1985;142:1061-1064. 8. Brent DA, Perper JA, Goldstein CE, Kolko DJ, Allan MJ, Allman CJ, Zelenak JP. Risk factors for adolescent suicide . Arch Gen Psychiatry . 1988;45:581-588.Crossref 9. Runeson B. Mental disorder in youth suicide: DSM-III-R Axes I and II . Acta Psychiatr Scand . 1989;79:490-497.Crossref 10. Marttunen MJ, Aro HM, Henriksson MM, Lonnqvist JK. Mental disorders in adolescent suicide . Arch Gen Psychiatry . 1991;48:834-839.Crossref 11. Arato M, Demeter E, Rihmer Z, Somogyi E. Retrospective psychiatric assessment of 200 suicides in Budapest . Acta Psychiatr Scand . 1988;77:454-456.Crossref 12. King RA, Pfeffer C, Gammon DG, Cohen DJ. Suicidality of childhood and adolescence: review of the literature and proposal for establishment of a DSM-IV category . In: Lahey BB, Kazdin AE, eds. Advances in Clinical Child Psychology . New York, NY: Plenum Press; 1992:297-325. 13. Van Praag HM, Kahn R, Asnis GM, Wetzler S, Brown SL, Bleich A, Korn ML. Denosologization of biological psychiatry, or the specificity of 5-HT disturbances in psychiatric disorders . J Affect Disord . 1987;13:1-8.Crossref 14. Levav I, Aisenberg E. Suicide in Israel: cross national comparisons . Acta Psychiatr Scand . 1989;79:468-473.Crossref 15. Levav I, Aisenberg E. The epidemiology of suicide in Israel: international and intranational comparisons . Suicide Life Threat Behav . 1989;19:184-200. 16. Reiger DA, Myers JK, Kramer M, Robins LN, Blazer DG, Hough RL, Eaton WW, Locke BZ. The epidemiologic catchment area program . Arch Gen Psychiatry . 1984;48:934-941.Crossref 17. Dohrenwend PB, Levav I, Shrout PE, Link BG, Skodol A, Martin J. Life stress and psychopathology . Am J Community Psychol . 1987;15:677-715.Crossref 18. Gal R. A Portrait of the Israeli Soldier . New York, NY: Greenwood Press; 1986. 19. Fishman G, Morris-Dycian A, Kotler M. Suicide in the Israeli army . Suicide Life Threat Behav . 1990;20:225-239. 20. Allebeck P, Allgulander C, Fisher LD. Predictors of completed suicide in a cohort of 50 465 young men: role of personality and deviant behavior . BMJ . 1988;297;176-178.Crossref 21. Angst J, Clayton P. Premorbid personality of depressive, bipolar, and schizophrenic patients with special reference to suicidal issues . Compr Psychiatry . 1986;27:511-532.Crossref 22. Brent DA, Perper JA, Allman CJ. Alcohol, firearms, and suicide among youth: temporal trends in Allegheny County, Pennsylvania, 1960-1983 . JAMA . 1987;257:3369-3372.Crossref 23. Schuckit MA, Schuckit JJ. Substance use and abuse: a risk factor in youth suicide . In: Alcohol, Drug Abuse, and Mental Health Administration Report of the Secretary's Task Force for Youth Suicide: Risk Factors for Youth Suicide . US Dept of Health and Human Services publication (ADM) 89-1622. 1989;2:172-183. 24. Van Vranken EW, McCraig CM, Golembe EH. US Army, Europe (USAREUR) Active Duty Suicides: US Army Medical Research Unit-Europe, Seventh Medical Command . Washington, DC: Walter Reed Institute of Research; June 20, 1986. 25. Rothberg JM, Fagan J, Shaw J. Suicide in United States Army personnel, 1985-1986 . Mil Med . 1991;155:452-456. 26. McDowell CP. Suicide Among Active Duty US Air Force Members, 1980-1989 . Washington, DC: USAF Office of Special Investigations, Bolling Air Force Base; April 1990. 27. Rothberg JM, Bartone PT, Holloway HC, Marlowe DH. Life and death in the US Army: in corpore sano . JAMA . 1990;264:2241-2244.Crossref 28. Redlich FC, Freedman DX. The Theory and Practice of Psychiatry . New York, NY: Basic Books; 1966. 29. Frances A, Blumenthal SJ. Personality as a predictor of youthful suicide. In: Alcohol, Drug Abuse, and Mental Health Admistration Report of the Secretary's Task Force for Youth Suicide: Risk Factors for Youth Suicide. Washington, DC: US Dept of Health and Human Services . US Dept of Health and Human Services publication (ADM) 89-1622 . 1989;2:160-171. 30. Shaffer D. Suicide in childhood and early adolescence . J Child Psychol Psychiatry . 1974;15:275-291.Crossref 31. Zetzel ER. The Capacity for Emotional Growth . London, England: Hogarth Press; 1970.

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Feb 1, 1993

References